ZENKER DIVERTICULUM TREATMENT: RETROSPECTIVE COMPARISON OF FLEXIBLE ENDOSCOPIC WINDOW TECHNIQUE AND SURGICAL APPROACHES

Aims:

Different therapeutic options exist for symptomatic Zenker diverticulum. During flexible endoscopy we add a technical trick called the “window technique” to improve the field of view. We evaluated the flexible endoscopy window technique to ENT surgical approaches, open cervicotomy or rigid endoscopy in terms of effectiveness and safety.

Methods:

All consecutive patients who underwent treatment for ZD were retrospectively included and divided into a gastro-intestinal (GI) endoscopic treatment group with window technique and an Ear Nose Throat (ENT) treatment group with either cervicotomy either rigid endoscopy. Data were analysed from medical records and a phone call with standardized questionnaire was attempted to evaluate pre and post-operative quality of life (QOL), residual symptoms and eventually delay of recurrence.

Results:

We analysed 106 patients who underwent a total of 128 interventions. Rigid endoscopy allowed the shortest procedure time (p < 0,001), with no difference between the 3 groups for adverse events. Endoscopic techniques (flexible and rigid) were associated with shorter delay of resumption for oral intakes (1 and 3 days respectively vs. 6 days after cervicotomy) and shorter length of hospital stay (3 and 4 days respectively vs. 7 days after cervicotomy) (p = 0,001). Mean follow up were respectively 41 and 35 months for GI and ENT groups. Post-operative QOL was higher after flexible endoscopy (9/10) and open cervicotomy (9/10) than after rigid endoscopy (7/10) (p = 0.004). There were more asymptomatic or poor symptomatic patients after open cervicotomy (77%) and flexible endoscopy (80%) than after rigid endoscopy (43%) (p = 0,003).

Conclusions:

Window technique is safe and effective during flexible endoscopic treatment of ZD and can be an alternative to surgical approaches thanks to its better effectiveness than rigid endoscopy and its earlier oral intakes resumption and shorter lengh of stay than cervicotomy.